Solvability of mental health care in the Family Health Strategy: social representation of professionals and users

Objective To aprehend the social representations about the solvability in mental health care with users of the Family Health Strategy and professionals of family health teams and of the Center for Psychosocial Care. Method A qualitative study using semi-structured interviews for data collection, and the Alceste software for analysis. This software uses the Hierarchical Descending Classification based on the examination of lexical roots, considering the words as units and providing context in the corpus. Results The representations emerge in two opposing poles: the users require satisfaction with care and the professionals realize the need for improvement of health actions. Although the matricial support in mental health and the home visits are developed, the barriers related to investment in health, continuing education and organization of care persist. Conclusion The different representations enable improvements in customer service, solvability of care and aggregate knowledge and practices in the expanded perspective of health needs in the family, social and therapeutic context

Institutional and matrix support and its relationship with primary healthcare

OBJECTIVE To analyze whether the level of institutional and matrix support is associated with better certification of primary healthcare teams.METHODS In this cross-sectional study, we evaluated two kinds of primary healthcare support – 14,489 teams received institutional support and 14,306 teams received matrix support. Logistic regression models were applied. In the institutional support model, the independent variable was “level of support” (as calculated by the sum of supporting activities for both modalities). In the matrix support model, in turn, the independent variables were the supporting activities. The multivariate analysis has considered variables with p RESULTS The teams had institutional and matrix supporting activities (84.0% and 85.0%), respectively, with 55.0% of them performing between six and eight activities. For the institutional support, we have observed 1.96 and 3.77 chances for teams who had medium and high levels of support to have very good or good certification, respectively. For the matrix support, the chances of their having very good or good certification were 1.79 and 3.29, respectively. Regarding to the association between institutional support activities and the certification, the very good or good certification was positively associated with self-assessment (OR = 1.95), permanent education (OR = 1.43), shared evaluation (OR = 1.40), and supervision and evaluation of indicators (OR = 1.37). In regards to the matrix support, the very good or good certification was positively associated with permanent education (OR = 1.50), interventions in the territory (OR = 1.30), and discussion in the work processes (OR = 1.23).CONCLUSIONS In Brazil, supporting activities are being incorporated in primary healthcare, and there is an association between the level of support, both matrix and institutional, and the certification result.</sec

O programa de qualidade no setor hospitalar e as atividades reais da enfermagem: o caso da medicação The quality program in the hospital sector and the nursing activities: the medication case

O objetivo deste estudo é analisar a política de qualidade implementada pela gestão hospitalar na farmácia central e as características da atividade de medicar realizada pelo auxiliar de enfermagem (AE). Adotou-se a abordagem proposta pela escola francesa de ergonomia. Avaliou-se o funcionamento do hospital e estudou-se a atividade do trabalho do AE em tempo real, possibilitando compreender as dificuldades enfrentadas no cotidiano e as estratégias implementadas. Viu-se que a atividade de trabalho está inserida num paradoxo organizacional em que a qualidade exigida para o cumprimento da missão de medicar dificulta o cumprimento da própria tarefa, comprometendo, em última análise, a assistência ao paciente.<br>The aim of this study is to analyze the quality policy implemented by the hospital management in the central chemistry and the characteristics of the medication activities performed by the nursing assistants (NA).The approach of the French School of Ergonomics was adopted. It was assessed the Hospital working situation and the activity performed by the nursing assistant in real time which have allowed to understand the difficulties faced by the workers and the strategies adopted to overcome them. It was observed that the working activity is part of an organizational paradox where the expected quality to fulfil the medication mission has been difficult to achieve, endangering, ultimately the assistance to the patients

Percepção de exposição a cargas de trabalho e riscos de acidentes em Pelotas, RS (Brasil) Workers' perception of exposure to occupational hazards and the risk of accidents in a Southern Brazilian city

OBJETIVO: Investigar a associação entre a percepção de exposição às cargas de trabalho e o risco de acidentes. MÉTODOS: O delineamento do estudo foi o tipo de casos e controles. Os casos (n=264) incluíram os acidentes de trabalho típicos notificados no Instituto Nacional de Seguridade Social, de Pelotas, RS (Brasil), de janeiro a julho de 1996. Foram excluídos os óbitos (dois), os acidentes ocorridos na zona rural, e os que afastaram o trabalhador de suas atividades por menos de sete dias. Para cada caso foram selecionados três tipos de controles: um trabalhador da mesma empresa, um vizinho e um controle populacional. Os controles foram emparelhados com os casos por idade e sexo e precisavam ter vínculo empregatício formal e não ter sofrido acidente no último mês. Os dados foram analisados usando regressão logística condicional. RESULTADOS E CONCLUSÕES: Os trabalhadores que relatavam enfrentar situações de emergência, o trabalho em altura, perigo constante, ou ambientes ruidosos tinham cerca de duas vezes mais risco de acidentar-se. O trabalho em posições incômodas ou com esforço físico intenso aumentaram em 50% o risco de acidentes. As demais cargas de trabalho estudadas não se constituíram como fatores de risco para os acidentes. Os resultados foram ajustados para fatores de confusão.<br>OBJETIVE: The study of the association between workers' perceptions of occupational hazards and the risk of occupational accidents. DESIGN: Case control study. POPULATION: The cases were 264 workers who presented a "typical" occupational accident, registered at the National Institute of Social Security in the city of Pelotas, between January and July, 1996. Fatal accidents (two) were excluded, as were those leading to an absence of less than seven days from work. The cases were interviewed in their homes with a standard questionnaire. For each case, three controls were chosen: a fellow-work, a neighbor and a population control. Controls were matched to the cases by age (± 5 years) and sex; workers who had suffered an occupational accident in the preceding month were excluded from the control group. All cases and controls were formally employed and lived in the urban area. The data were analyzed using conditional logistic regression. RESULTS AND CONCLUSIONS: The risk of occupational accidents was found to double among workers who reported having faced emergency situations at work, working in high places, facing constant danger or noisy environments. Working in uncomfortable positions or intense physical activities were associated with a 50% increase in risk. The remaining occupational hazards under study were not significantly associated with the risk of accidents. All of the above results were adjusted for confounding factors